title: Prognostication of neurologic outcome in cardiac arrest patients after mild therapeutic hypothermia: a meta-analysis of the current literature.
abstract: OBJECTIVE
  To assess the sensitivity and false positive rate (FPR) of neurological examination and somatosensory evoked potentials (SSEPs) to predict poor outcome in adult patients treated with therapeutic hypothermia after cardiopulmonary resuscitation (CPR).
  
  
  METHODS
  MEDLINE and EMBASE were searched for cohort studies describing the association of clinical neurological examination or SSEPs after return of spontaneous circulation with neurological outcome. Poor outcome was defined as severe disability, vegetative state and death. Sensitivity and FPR were determined.
  
  
  RESULTS
  A total of 1,153 patients from ten studies were included. The FPR of a bilaterally absent cortical N20 response of the SSEP could be calculated from nine studies including 492 patients. The SSEP had an FPR of 0.007 (confidence interval, CI, 0.001-0.047) to predict poor outcome. The Glasgow coma score (GCS) motor response was assessed in 811 patients from nine studies. A GCS motor score of 1-2 at 72 h had a high FPR of 0.21 (CI 0.08-0.43). Corneal reflex and pupillary reactivity at 72 h after the arrest were available in 429 and 566 patients, respectively. Bilaterally absent corneal reflexes had an FPR of 0.02 (CI 0.002-0.13). Bilaterally absent pupillary reflexes had an FPR of 0.004 (CI 0.001-0.03).
  
  
  CONCLUSIONS
  At 72 h after the arrest the motor response to painful stimuli and the corneal reflexes are not a reliable tool for the early prediction of poor outcome in patients treated with hypothermia. The reliability of the pupillary response to light and the SSEP is comparable to that in patients not treated with hypothermia.
authors.affiliation: Department of Intensive Care, Radboud University Nijmegen Medical Centre, Geert Grooteplein zuid 10, Nijmegen, 6525 GA, The Netherlands, marlijn.kamps@gmail.com.
authors.forename: M J A
authors.initials: MJ
authors.lastname: Kamps
authors.forename: J
authors.initials: J
authors.lastname: Horn
authors.forename: M
authors.initials: M
authors.lastname: Oddo
authors.forename: J E
authors.initials: JE
authors.lastname: Fugate
authors.forename: C
authors.initials: C
authors.lastname: Storm
authors.forename: T
authors.initials: T
authors.lastname: Cronberg
authors.forename: C A
authors.initials: CA
authors.lastname: Wijman
authors.forename: O
authors.initials: O
authors.lastname: Wu
authors.forename: J M
authors.initials: JM
authors.lastname: Binnekade
authors.forename: C W E
authors.initials: CW
authors.lastname: Hoedemaekers
mesh_terms: D000328:Adult; D001831:Body Temperature / Q000502:physiology*; D016887:Cardiopulmonary Resuscitation; D015331:Cohort Studies; D016206:Databases, Bibliographic; D005073:Evoked Potentials, Somatosensory / Q000502:physiology; D005189:False Positive Reactions; D023261:Glasgow Outcome Scale / Q000706:statistics & numerical data; D006323:Heart Arrest / Q000150:complications / Q000628:therapy*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007036:Hypothermia, Induced / Q000379:methods* / Q000706:statistics & numerical data; D009460:Neurologic Examination / Q000379:methods / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care / Q000379:methods* / Q000706:statistics & numerical data; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D006993:Hypnotics and Sedatives